WHO global strategy on diet, physical activityand health:

Western Pacific regional consultation meeting report

Kuala Lumpur, 9−11 June 2003

World Health Organization2003

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Towards a WHO global strategy on diet, physical activity and health

Background1979 The Global Strategy for Health for All by the year 2000 underlined the growing importance of chronic

noncommunicable diseases (NCDs) for developed and developing countries alike.1985 The Thirty-eighth World Health Assembly called for increased efforts to assess the importance of NCDs

and to coordinate long-term NCD prevention and control programmes (resolution WHA38.30).1989 The Forty-second World Health Assembly urged the promotion of intersectoral and integrated approaches

for the prevention and control of NCDs, especially at the community level in developing countries(resolution WHA42.45).

1990 In its report Diet, nutrition and prevention of noncommunicable diseases, a WHO Study Group maderecommendations to help prevent chronic diseases and reduce their impact (WHO Technical ReportSeries, No. 797).

1992 The FAO/WHO International Conference on Nutrition adopted the World Declaration on Nutrition and thePlan of Action for Nutrition with the participation of 159 states and the European Economic Community.The Plan of Action for Nutrition promoted 9 strategies for improving nutritional status, one of whichaddressed the need to promote appropriate diets and healthy lifestyles to prevent NCDs. In the followingyears the majority of countries prepared and launched national plans of action for nutrition, based on theglobal plan and its strategies.

1997 The world health report 1997. Conquering suffering, enriching humanity described the high rates ofmortality, morbidity and disability from the major NCDs and proposed the development of a global strategyfor NCD prevention and control.

1998 Recognizing the burden on public health services resulting from the growth in NCDs, the Fifty-first WorldHealth Assembly requested the Director-General to formulate a global strategy for NCD prevention andcontrol (resolution WHA51.18).

2000 The Fifty-third World Health Assembly endorsed the WHO global strategy for NCD prevention and controland urged Member States and WHO to increase efforts to combat NCDs (resolution WHA53.17).

2001 A WHO consultation called for urgent action to combat the growing epidemic of obesity, stressing theimportance of prevention (Obesity: preventing and managing the global epidemic. Report of a WHOconsultation. WHO Technical Report Series, No. 894).

2001 Macroeconomics and health: investing in health for economic development, the final report of theCommission on Macroeconomics and Health, noted that many NCDs can be effectively addressed byrelatively low-cost interventions, especially prevention activities related to diet and lifestyle.

2002 Having considered a report on diet, physical activity and health, the Fifty-fifth World Health Assemblyrequested WHO to develop a global strategy on diet, physical activity and health (resolution WHA55.23).

2002 “Move for health” was the theme for World Health Day, 7 April 2002. “Move for health” has become acontinuing initiative across the world.

2002 The world health report 2002. Reducing risks, promoting healthy life described how a few major risk factorsaccount for a significant proportion of all deaths and diseases in most countries. For chronic NCDs, someof the most important include tobacco consumption, overweight and obesity, physical inactivity, low fruitand vegetable intake, and alcohol consumption, as well as the risks posed by intermediate outcomes suchas hypertension and raised serum cholesterol and glucose levels.

2002 A joint FAO/WHO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases examinedthe latest scientific evidence available and updated recommendations for action (see below, Phase I, fordetails of its report published in 2003).

2003 The Framework Convention on Tobacco Control was adopted by the Fifty-sixth World Health Assembly inMay 2003 (resolution WHA56.1).

Development of the global strategy2003 Phase I

Finalization and dissemination of Diet, nutrition and the prevention of chronic diseases. Report of a jointFAO/WHO Expert Consultation (WHO Technical Report Series, No. 916).Phase IICirculation of a consultation document to guide development of the strategy. Document made publicthrough WHO web-site – January 2003.Six regional consultations to gather information that will form the basis of the strategy (March–June 2003).Consultations with relevant United Nations and other international organizations, with civil societyorganizations and with the private sector (May–June 2003).Phase IIIReference Group, a group of internationally recognized experts, to advise WHO on the preparation of adraft global strategy.Completion of the draft strategy (October 2003).

2004 Submission of the draft strategy to the Executive Board at its 113th session (January 2004).Revision of the draft strategy to take into account the Board’s comments.Discussion of the revised draft strategy at the Fifty-seventh World Health Assembly (May 2004).

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Contents

Preface ....................................................................................................................................... 51. Introduction ......................................................................................................................... 62. The global perspective ........................................................................................................ 8

2.1 Health in transition ............................................................................................ 82.2 Physical activity programmes ......................................................................... 10

3. The regional perspective ................................................................................................... 113.1 Dietary guidelines development and utilization in the Region ....................... 113.2 The regional noncommunicable disease network ........................................... 12

4. Regional issues raised by the working groups..................................................................... 135. Conclusions and recommendations ..................................................................................... 14

5.1 Conclusions ...................................................................................................... 145.2 Recommendations ........................................................................................... 15

Annex List of participants ..................................................................................................... 21

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PrefaceThis report of the consultation in the Western Pacific Region, on the global strategy

on diet, physical activity and health, is the last in a series of six. Organized by the RegionalOffice for the Western Pacific the consultation gave the Member States’ perspective on theissues encountered and made specific recommendations on direction, both for the countries ofthe Region, and for the development of the global strategy. As a whole, the series of reportsprovides a summarized global account of the status of knowledge about the links betweendiet, physical activity and health, and the work in countries to address the pandemic ofchronic diseases. Added to this will be contributions from consultations with other UnitedNations organizations, civil society and the private sector. Together these will provide astrong foundation for the development and formulation of the Global Strategy on Diet,Physical Activity and Health and subsequently for action to make measurable changes in dietand physical activity at population level, with positive consequences for the prevention ofnoncommunicable diseases (NCDs).

As a result of the consultation in the Western Pacific Region, the following key issueswere identified and recommendations to address them formulated: development of nationalpolicies and plans of action related to diet and physical activity; advocacy for governmentaction and awareness-raising for the public; food regulatory approaches to support the globalstrategy; creation of environments that promote physical activity; promotion of healthy dietsand active lifestyles in specific settings; and the development of plans and processes for aregional NCD network. This report summarizes the discussions at the consultation andoutlines the recommendations made.

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1. IntroductionNoncommunicable diseases, especially cardiovascular diseases (CVDs), cancers,

obesity and type 2 diabetes mellitus, now kill more people every year than any other cause ofdeath. The World Health Organization (WHO) has responded to the global rise in NCDs bygiving increasing attention to their prevention and control in recent years (see Box on page 3)

Four factors in the epidemiology of these diseases – poor diet, physical inactivity,tobacco and alcohol use – are of overwhelming importance to public health. Diet and physicalactivity have recently been the subject of intensified high-level attention by a JointWHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases.1The report of the Expert Consultation makes recommendations, inter alia, for optimumnutrition and for worldwide action to stimulate physical activity within a health context.WHO is currently developing a global strategy on diet, physical activity and health to giveeffect to these and other recommendations.

The Western Pacific regional consultation on the development of the global strategyon diet, physical activity and health was held in Kuala Lumpur, Malaysia, from 7 to 9 June2003, and was attended by participants and observers from 15 Member States, representativesfrom the Food and Agriculture Organization of the United Nations (FAO), the United NationsEconomic and Social Commission for Asia and the Pacific (UNESCAP) and the Secretariat ofthe Pacific Community (SPC), five technical resource persons and WHO regional andheadquarters staff (Annex). Participants represented a wide range of sectors including foodand nutrition, physical activity, sport, agriculture, health promotion, environment andeducation. Dr Zainal Ariffin Omar (Malaysia) was elected Chairman, Dr Intan Salleh (BruneiDarussalam) was elected Vice-Chairman, and Dr Colin Tukuitonga (New Zealand) waselected Rapporteur.

Dr Tommaso Cavalli-Sforza, Responsible Officer for the meeting, spoke in welcometo all participants and introduced the programme of the consultation activities for the threedays. Dr Kingsley Gee, WHO Representative, Malaysia, speaking on behalf of the RegionalDirector for the Western Pacific, Dr Shigeru Omi, thanked the Government of Malaysia forhosting the consultation, and greeted all participants. Reviewing the increasing death toll fromNCDs and their drain on health resources, he questioned why the risk factors leading to thesediseases were growing so fast in the Region. The answers included the many sectors outsidehealth that strongly influence the physical and political environments that determine health,and the consequent need to change values, set up role models for effective communication,support environmental change and strengthen preventive health services. Three high-levelmeetings had contributed in particular to these conclusions: the Ministerial round table duringthe fifty-third session of the Regional Committee, the International Conference on HealthConference on Health Promotion (organized by the Japanese Government), in 2002, and theMeeting of Ministers of Health for the Pacific Island Countries, in 2003. Although much hadalready been accomplished, he identified five areas for further work: the characteristic “short-sightedness” of people, which prevents them from translating their knowledge into healthybehaviours; interaction with the media to achieve mobilization of decision-makers and thepublic; relationship building with relevant industries that takes sophisticated account of theissues involved; changing emphasis within health systems, routinely using clinical servicesfor health promotion; and managing environment changes in such a way as to mitigate thenegative effects of change without losing the positive aspects. Several examples showed thathealth promotion really worked and that preventive measures, well executed, gave rapidresults. Communication, environmental support, and health promotion throughout the lifecourse, involving clinical workers in prevention, would be key strategies.

Dr Biplab K Nandi, Senior Food and Nutrition Officer, FAO Regional Office for Asiaand the Pacific, representing the FAO Assistant Director-General and Regional

1 Diet, nutrition and the prevention of chronic diseases. Report of a Joint FAO/WHO ExpertConsultation. Geneva, World Health Organization, 2003 (WHO Technical Report Series, No. 916).

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Representative for Asia and the Pacific, recalled how the scientific evidence gathered over thelast decade had clarified the role of diet in preventing and controlling morbidity andpremature mortality from NCDs, with specific components and interventions in that processidentified. Factors such as urbanization, diversification of diet through expansion of foodavailability and supply, and changes in the world food economy all contributed to shifts indietary patterns. The effect was to support energy-dense diets high in fats, especially saturatedfats, and low in unrefined carbohydrates, coupled with a decline in energy expenditure,associated with sedentary lifestyles, and the resulting growth of NCDs seen in the Region.FAO and WHO collaboration had recently included the Joint WHO/FAO Expert Consultationon Diet, Nutrition and the Prevention of Chronic Diseases, and widespread advocacy on food-based dietary guidelines. He welcomed the fact that FAO nutrition education tools wereincreasingly being used and invited further collaboration to apply innovative and successfulmethods and communication strategies to improve nutritional well being and address NCDs.

Dr Shafie bin Ooyub, Director, Disease Control Division, Ministry of HealthMalaysia, spoke on behalf of the Minister of Health, Malaysia, Dato' Chua Jui Meng, toexpress the Minister’s welcome to all participants to the consultation and to Malaysia, tooutline the epidemiological situation in the Region as regards NCDs, and the crucial role ofdietary measures and physical activity in preventing the spread of chronic diseases such ascardiovascular disease and diabetes mellitus, two of the most significant contributors tomortality in the Region. Referring to Malaysia’s own track record since 1991 in promotinghealthy lifestyles and establishing an appropriate health infrastructure (the NationalCoordinating Committee for Food and Nutrition, 1994, a National Plan of Action for FoodSafety and Nutrition for Malaysia 1996-2000, and a National Council for Food Safety andNutrition, 2002), he noted that work was still needed to get the desired effects, and that thiswould require action by individuals, professionals, communities and governments.

Dr Pekka Puska, Director, Noncommunicable Disease Prevention and HealthPromotion at WHO headquarters, describing the process of formulating the strategy, stressedthe value of country and regional input and thanked the participants for convening to sharetheir experience.

After a series of presentations by WHO staff and scientific experts (summarized insections 2 and 3), the participants worked in groups to examine the key issues in relation todiet and nutrition, and to physical activity, and to identify the barriers and obstacles toprogress, priority actions and key players in these two areas (section 4). On the basis of thediscussions in these groups, the consultation adopted a series of recommendations (section 5).

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2. The global perspective

2.1 Health in transitionThe world’s health is undergoing an unprecedented transition on several fronts:

epidemiological, nutritional and demographic. The result, felt keenly at country level andsubstantiated unequivocally by scientific evidence, is a broad shift in disease burden. Themajority of deaths (59%) are from NCDs (Figure 1).

Injuries (9%) Noncommunicableconditions (59%)

Communicable diseases, maternal andperinatal conditions and nutritional

deficiencies (32%)

Total deaths: 55,694,000

Source: WHO, World Health Report 2001

Figure 1Death, by broad cause group 2000

In the European, American and Western Pacific Regions, NCDs are in anoverwhelming majority. The South-East Asia and Eastern Mediterranean Regions are intransition, with NCDs now a more significant public health problem than infectious diseases(Figure 2).

Figure 2Deaths, by broad cause group and WHO Region, 2000

InjuriesNoncommunicableconditions

Communicable diseases, maternaland perinatal conditions andnutritional deficiencies

AFR EMR EURSEAR WPR AMR

25

50

75

%

Source: WHO, World Health Report 2001

The African Region is also in transition and, while in many countries in the Regioncommunicable diseases still predominate, the incidence of NCDs is rising rapidly.

A wealth of medical research shows the risk factors responsible for this growingpandemic and clearly points out the strategies needed to reduce their impact. The datagathered for The world health report 2002 show high blood pressure to be the majorcontributing factor to all deaths in the world (Figure 3).2 It is also the leading risk factor in theWestern Pacific Region, with deaths due to cerebrovascular stroke particularly high in the 2 The world health report 2002. Reducing risks, promoting healthy life. World Health Organization,Geneva, Switzerland, 2002.

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Region. Of the ten leading risk factors globally, six relate to nutrition, diet and physicalactivity. In the Western Pacific Region, this amounts to five out of ten. Progress in these twoareas, combined with reductions in tobacco and alcohol use, will have enormous importancefor the prevention of NCDs and will lead to major health gains that are cost-effective.

0 10 00 2 000 30 00 4 000 5 000 6 000 7 00 0 8 000

O ccup ationa l risk fac to rs for in ju ry

Un safe hea lth care in jections V itamin A deficiency

Z inc defic iency Urban air pollution

Iron defic iency

Indoo r smoke from solid fuels

Unsafe w ater, san itat ion , and hyg iene

A lcoh ol Physical in activity

High Bod y M ass In dex

Fruit and vegetab le in take Un safe sex

U nderw eig ht

C ho lesterol

To bacco

Blood p ressu re

Figure 3Global deaths in 2000 attributable to selected leading risk factors

Number of deaths (000s)

Source: WHO, World Health Report, 2002

The figures also make clear the important role played by undernutrition. This mustnot be forgotten in the concern to address overnutrition. In many countries, both forms ofmalnutrition co-exist. Balanced diet can play an essential role in improving population health.Childhood obesity too is a growing problem across the world, with physical inactivity a majorfactor.

Close to 80% of the NCD burden is now found in the developing world, moving tolower and lower socioeconomic groups and contributing strongly to inequities in health. Thedeterminants of these changes are urbanization, changes in occupation and many globalinfluences. The transition concerns adults and children alike.

NCDs are to a great extent preventable diseases. While genetic susceptibility toNCDs may be a factor, appropriate preventive action can alter environments, protect againstrisk factors and change life expectations. On a population scale, relatively modest behaviouralchanges affecting several of the risk factors simultaneously, can make swift, affordable anddramatic changes in population health.

Diet is a powerful instrument in this regard. In Finland, the North Karelia projectreduced annual CHD mortality by 73% over 25 years through community-based activityencouraging a healthier diet. In Japan, reduction of salt intake resulted in lower bloodpressure levels and greatly reduced stroke mortality; in Mauritius, changing cooking oil frompalm to soy bean oil resulted in a 15% decrease in serum cholesterol in the population; and inPoland, a change in dietary fats resulted in a 20% decline in heart disease mortality.

There are many obstacles to implementing prevention activities, but they can beovercome. They include: outdated concepts such as seeing NCDs as “diseases of affluence”; alack of understanding about the speed with which prevention activities can make an impact onmorbidity; low public visibility for success stories in comparison with the needs of sickpatients; powerful commercial interests that block policies and generate conflicting messages;traditional training of health personnel that emphasizes curative care; and inertia amonginstitutions, financing bodies and services.

Food consumption and physical activity patterns are a key to tackling NCDs.However, these behaviours are embedded in the environment, the community, and in areassuch as agriculture and food policies. An extensive consultation process has taken place, withMember States throughout the world, and with the wide range of stakeholders involved in theprocess. In May 2003 the Director-General of WHO held a meeting with high-level privatesector representatives, and a second one with nongovernmental organizations (NGOs). InJune 2003 WHO met with other United Nations agencies, to raise issues such as increasedcollaboration, a raised profile for nutrition and physical activity, and research priorities. It willbe essential to work with all these sectors, and to look carefully at what factors influenceconsumption patterns in dialogue with partners and stakeholders. The problems are complex,

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and cannot be solved by any one entity on its own. The consultation process for the globalstrategy will draw all partners and stakeholders into debate, with the specific intention ofworking positively towards change. WHO is confident that, with this background and throughbroad consultation, the global strategy will be successfully developed and implemented,leading to major health gains in Member States and globally.

2.2 Physical activity programmesPhysical inactivity is a major risk factor for NCDs, however action to address this is

still under-resourced. This is partly attributable to methods of quantifying the risk posed bylack of physical activity, which have led to an underestimation of its real place in the rankingof risk factors for chronic disease and overall health (The world health report 2002 rankedphysical inactivity in sixth place in terms of world attributable mortality in 2000 and inseventh place in terms of the ten leading risk factors as causes of disease burden). Thisreinforces the need for a global strategy that can coordinate data and action and assertpriorities.

Physical activity has both direct and indirect effects on health. It providesindependent risk reduction for coronary heart disease (CHD) and stroke; it is as important asobesity in the incidence of diabetes in populations and it is influential on other risk factorsthat are themselves risk factors for NCDs. In addition to this, it has a moderating effect on therelationship between, for example, obesity and CHD.

A growing multiplicity of physical activity guidelines has caused a degree of publicconfusion and diluted the messages. The standard recommendation for physical activity toreduce risk is for individuals to accumulate 30 minutes of moderate intensity activity eachday.3 Where possible, vigorous activity should also be undertaken. For weight reduction ormaintenance, 60−90 minutes of at least moderate activity may be necessary. It is important tobe clear that the goal is increased population levels of energy expenditure, and not necessarilyimprovement of fitness levels.

The “domains” where people expend energy are various: in their leisure time; inorganized sport or recreation; in the working environment, in the domestic setting; and intravel/transportation. Experience of which modifiable factors are usually associated withphysical activity will be important in planning programmes and strategies. These include:social support for activity, previous adult participation in physical activity; enjoyment ofphysical activity; and a lower intensity of activity. Examples of factors that have been shownnot to be related are equally important, and these include: knowledge about exercise;participation in sports in youth; normative beliefs, and susceptibility to illness. In the sameway, shared “best practice” evidence is crucial in planning the most effective way ofpromoting physical activity. Two areas that have been shown not to work are: worksiteprogrammes, and small group individual change programmes. However, strategies that haveworked to some degree are: primary care physicians’ advice and counselling (in the shortterm); comprehensive multi-strategy school-based programmes, which must includeparticipation by all students; and adequately funded media campaigns. Promising approachesfor the future include: changing the physical environment to increase opportunities to beactive; changing the social environment to make daily physical activity more important inpeople’s lives; and integrated, multi-strategy, multi-agency long-term (10−20 year) initiatives.

There is limited data available from the Western Pacific Region on trends in physicalactivity, however, it appears that there may have been some increase nationally in NewZealand, through the “Push play” initiative, encouraging a minimum of 30 minutes ofphysical activity, supported by a national awareness-raising campaign. Singapore also haspromising early results with its “Trim and fit” campaign, aimed at reducing childhoodobesity. There are, however, declines in physical activity levels in Australia. Elsewhere,

3 United States Surgeon General’s Report on Physical Activity and Health, 1996; and Diet, nutritionand the prevention of chronic disease. Report of a Joint FAO/WHO Expert Consultation, 2003, op. cit.

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countries such as the United States of America do not seem to show any change at all, andonly Canada and Finland show increases.

For the future, countries will need to develop national strategies, looking to engineera culture change to increase total daily physical activity, through innovative approaches,multiple agencies to work on inducing change, and resource commitment. Surveillancethrough standardized methods and national monitoring will also be key aspects of recordingand observing change.

3. The regional perspective

3.1 Dietary guidelines development and utilization in the RegionThe Report of a Joint FAO/WHO Expert Consultation4 identified six strategic actions

for promoting healthy diets and physical activity. The second of these was “enabling peopleto make informed choices and to take effective action”. In this regard, much emphasis hasbeen given to the development of health and nutritional literacy, and dietary guidelines are akey consideration in this effort. Thirty-one countries and areas of the Region completed aquestionnaire on the development and utilization of such guidelines.

Of the 71% of countries that have a dietary guideline, 82% have single guidelines,addressing the general public (or in one case, addressing children and mothers). Although allof those guidelines have been promoted and disseminated to a wide variety of audiences andthrough a range of venues, evaluation has been limited to investigation of specific elements,with overall effectiveness generally not assessed.

Information on the core messages of the guidelines is drawn from the ten sets ofcountry guidelines submitted with the questionnaires. The messages have grown in specificityover the period during which guidelines have been developed (between 1990−2002), evenincluding direction as to the food or food groups to be consumed, and the dietary patterns tobe followed. Within a framework of advocating nutritional balance, the guidelines respondedto issues both of undernutrition and overnutrition. Core messages included: consuming avariety of foods; eating fruits and vegetables; including sufficient grains/cereals; eating morefibre; including calcium-rich foods and protein-rich foods in the diet; drinking sufficient andclean fluids, restricting the use of fats and oils and being selective about the types of fatsused; using less salt (and preferably choosing iodized salt), and eating less-salty foods, cuttingdown on sugar, and on drinks and foods that contain sugar; encouraging exclusivebreastfeeding of babies for six months and continued breastfeeding combined with suitablecomplementary foods after six months; maintaining a healthy body weight; encouragingphysical activity and exercise and suggesting its minimum duration; controlling alcoholintake; and stopping or avoiding tobacco use. Beyond these messages are other importantmessages on topics such as: assessing daily eating; taking advantage of local dietary cultureand local food products; enjoying meals; keeping regular hours for meals; home-growingfoods where possible; preparing and storing foods properly; eating clean and safe foods; andtaking care with child-feeding, to help children achieve healthy eating habits and support theirproper growth.

Concerns raised by Member States focused on assistance with the development,promotion and evaluation of the guidelines. Issues were raised such as whether to promote allof the messages within the guidelines simultaneously or whether to focus on one message at atime. A prominent theme in the comments on evaluation was that there should be a commonforum in the Region for sharing experience, in terms of utilization, understanding, andinformation on whether the guidelines were effective in altering the diets of the populations.

The attention of the participants attending the consultation was drawn to the existenceof the WHO/FAO document on the preparation and use of food-based dietary guidelines 5

4 Op. cit.5 Preparation and use of food-based dietary guidelines. Report of a Joint FAO/WHO Consultation.Geneva, World Health Organization, 1998 (WHO Technical Report Series, No. 880)

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resulting from a consultation. The concerted cooperation of both the agriculture and healthministries in designing and implementing such guidelines is essential coming up with aneffective end-product that will address NCDs.

3.2 The regional noncommunicable disease networkThe mandate for action on NCDs is already firmly in place in the Western Pacific

Region, through such policy statements as the Pacific Island Countries’ “Call for Action onObesity” in 2000, and the Madang Commitment in 2001, the Western Pacific Declaration onDiabetes in 2000 and the Tonga Commitment in 2003 to a “STEPwise Framework for NCDIntervention”. Strong surveillance is already in place through the STEPS programme, nationalNCD plans are either under development or already in place in several countries, obesityprevention and control projects have been supported by WHO in two Pacific Island countries,with more to follow, and clinical management guidelines are being developed andimplemented in several countries in the Region, with the challenge foreseen for the future ofdeveloping evidence-based algorithmic guidelines appropriate for the resource base. Throughthese activities, and many more, a considerable body of experience is already building in theRegion, which will support the implementation of the global strategy on diet, physical activityand health, and complement the work proposed for the regional NCD network ─ proposed tobe called MOANA (Mobilisation Of Allies in NCD Action).

International experience of the success of networks in other regions such as CINDI(the Countrywide Integrated Noncommunicable Diseases Intervention, in the EuropeanRegion and the CARMEN project (Conjunto de Acciones para la Reducción Multifactorial delas Enfermedades No Transmisibiles; actions for the multifactorial reduction ofnoncommunicable diseases), in the Region of the Americas, provides a useful basis for thedevelopment of a similar process in the Western Pacific Region, as mandated by the RegionalCommittee for the Western Pacific in 2000 (Resolution WPR/RC51.R5), and further developedby numerous meetings, round tables and declarations on the area of NCD prevention. TheGlobal Forum, which fosters regional and national networks, also provides a possibletemplate. The Forum disseminates evidence and guidance on primary and secondary NCDprevention, supports advocacy for increased NCD awareness, harmonizes surveillancemethods, and promotes and contributes to collaborative research and capacity-building,especially in developing countries.

There are several key concepts behind these international NCD networks, on whichthe Western Pacific Region’s proposed network would draw:

• First, the national NCD policy and demonstration areas: these have been acentral aspect of the CINDI country programmes. They test interventionapproaches, raise public awareness of prevention, produce models forextension to other parts of the country, work as a powerful tool for thedevelopment of national health policy, and provide opportunities to buildskills.

• The second concept is of integrated, intersectoral, community-based action.These facets are well demonstrated by the CARMEN project, which cruciallydoes not work on a vertical programme structure but recognizes the linkagesbetween the intermediate risk factors and the ultimate determinants of NCDs,taking approaches that focus on populations and high-risk groups. Action isacross all governmental and nongovernmental partners, with closeinternational collaboration with CINDI.

• The third element is the specific commitment of resources and theestablishment of a structure by the governments that apply for membership inthe network.

• Fourth: there are agreed common surveillance and evaluation protocolsacross the networks, with centralized data management (as in CINDI) andexternal review, to chart the progress of the project.

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• Fifth: there is country autonomy in the selection of priorities and specificprogrammes, to ensure that they are appropriate and consistent.

• Sixth: linkages with other networks such as healthy settings (Healthy Cities,Safe Communities etc) provide mutual extension of scope, underscore thehealth services contribution to community action (for example against riskfactors such as hypertension), emphasize formal project planning within thenational policy, and provide a theoretical approach to evaluation andmonitoring.

• Lastly, formal dissemination processes are a key concept. These includeregular meetings, telephone conferences, newsletters, electronic links,strategic position papers, training workshops, a pool of institutions, experts,and short-term consultants that can provide expertise; a directory of plannedand ongoing community-based activities and short-term working groups onspecific areas identified by the forum or network.

4. Regional issues raised by the working groups

The following issues are drawn from the collective experience of the Member States.

Through small group meetings, a synthesis of points was drawn from countryexperiences with a view to establishing what were the successes, challenges, and lessonslearnt from national efforts to promote a healthy diet and active lifestyle.

Australia, Japan, the Republic of Korea and New Zealand described successes suchas: the regularly gathered national data sets through which progress could be measured;national health regulatory and legislative mandates; comprehensive long-term healthpromotion programmes; the targeting of disadvantaged populations; integration acrosssectors; political mobilization; and an appropriate mix of culturally specific messages andprogrammes (in New Zealand). Challenges included: the need for long-term commitment;complex political structures and cycles; high prevalences of NCDs with risk factorsincreasing; the erosion of traditional diets; the need to engage with the private sector; andincreasing prevalences of underweight among young females (in Japan). Lessons learntincluded: the development of appropriate industry relationships, producing clear healthbenefits; improvements in marketing messages and in working across government and withNGOs; increased equity focus; the need to undertake health impact assessment of newpolicies, and to establish creative legislative mandates wherever possible.

China, Malaysia, Mongolia and French Polynesia reported successes in achievinghigh-level political commitment; intersectoral collaboration, with the development of nationalplans and strategies; the promulgation of legislation, regulation and codes, for example onlabelling of nutritional content; active NGOs; and mass organized communication strategies,such as healthy lifestyle campaigns. The challenges discussed included: achievingintersectoral collaboration at national level; decentralization of public investment; theperception that NCDs are non-urgent matters; insufficient capacity in intervention and socialmobilization; legislation; and monitoring and evaluation. The lessons learnt were: how mediaadvocacy can be used to change public policy; the need to promote correct and responsibleadvertisements; the value of partnership with the media; the need for a multi-strategyapproach in social marketing; the utility of the healthy settings approach; the importance ofsupportive environments for physical activities; and the need for continued monitoring andevaluation.

Cook Islands, Fiji, Kiribati, and Tonga described their successes as including: thedevelopment of NCD prevention and management guidelines; collaboration with a variety ofstakeholders; budget allocation for preventive activities; strong “Healthy Island” projects;strong national nutrition committees; a range of supportive policies and legislation; increasedawareness about the role of physical activity in health; increased acceptability of culturally

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appropriate exercise (in Tonga) and, in Kiribati, where previously, in the tradition of gift-giving, tobacco was given as a present, this has changed to gifts of sports equipment instead.The challenges include: lack of human resources, budget and data; obstructive local culturalbeliefs and policies; political instability; expensive media; a poor natural environment; thehigh cost of healthy food; and industry sponsorship, which has moved from the tobaccoindustry to the food industry. The lessons learnt include: the need to plan in sustainabilityfrom the start of projects and involve the community in planning and implementation; therequirement for a strong national coordinating body and an active focal NCD point; the utilityof proactive work with the food industry; the value of relationship building with the media;ways of strengthening surveillance programmes; supporting consumer and community voices;how to extend health-promoting settings through other activities; the need to seek high-levelcommitment and supportive legislation; tailor activities to the local environment; and usinglocal plans to seek funding from donors.

Brunei Darussalam, the Philippines, Singapore and Viet Nam described theirsuccesses as including: the establishment of some form of national public health developmentplan or national nutrition plan; these set the stage for healthy lifestyle campaigns andprovided mechanisms for intersectoral collaboration; establishment of high-profile rolemodels, such as the Sultan of Brunei; the surveillance and assessment of risk factors; raisingof awareness; schools programmes; participation (in Singapore) in the “healthy choice”programme, for example, adherence by companies to “healthy choice” labelling. Challengesincluded: the need for the global strategy to take into account the differing levels ofdevelopment among countries; the variety of experience available in monitoring andevaluating interventions; the need for trained human resources; the strategies to control adouble burden of overnutrition and undernutrition; the need to ensure food safety in thecontext of overuse of pesticides and chemical fertilisers; the difficulties of sustainingawareness and translating it into practice; the need to identify clear roles for stakeholders inan intersectoral process; the issue of conflict of interest in the context, for example, ofsponsorship; the difficulties in enforcement of legislation or codes of practice; the sustainedinvolvement of local government; the achievement of balance in the relationship with foodproducers (no “endorsement”). General considerations were outlined: despite low awareness,micronutrient fortified foods were consumed (in the Philippines) because of competitivepricing and appropriate selection of products. Culture and gender-sensitive programmes (inViet Nam) promote the life of communities, and (in Brunei) traditional recipes, dances, andmartial arts are adapted. National and international strategies need to take into account thelocally produced and fresh foods available from the strong agricultural basis of most of thecultures of the Region.

5. Conclusions and recommendations

5.1 Conclusions

1. The summary of ideas and experiences discussed at the Ministerial round table during thefifty-third session of the Regional Committee for the Western Pacific in 2002 togetherwith its recommendations, forms a useful contribution to the development of the globalstrategy on diet, physical activity and health.6

2. Through the Ministerial round table meeting, and several other important high-levelmeetings in the Region, there is increased awareness among decision-makers of theimportance of the NCD issue and motivation to make progress in developing the globalstrategy and the tools and processes through which to implement it.

6 Ministerial round table on diet, physical activity and health, Regional Committee for the WesternPacific. Fifty-third session, 16−20 September 2002, World Health Organization, 2003.

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3. Promotion of a healthy diet and active lifestyle can be effectively accomplished through a“settings” approach, interpreted as places where people work and study, play andsocialize.

4. It is vital that all initiatives are well supported by media, social marketing and promotionexercises that are well planned, executed, and adequately funded.

5. Although good work is ongoing in systematic collection of data in the Region, there is aneed to overcome obstacles such as the lack of food consumption and physical activitydata in countries and to assemble regional databases in conjunction with importantpartners such as FAO.

6. Country studies on determinants of dietary patterns and lifestyles are needed as a basis fordesigning effective health promotion campaigns.

7. Planning and implementation of interventions to promote healthy diets and physicalactivity should be targeted especially to sectors of the population with the highest risk ofnutrition-related NCDs, including the poor and minority groups, where relevant.

5.2 Recommendations

The following six areas were those considered to be particularly important for thedevelopment and implementation of the global strategy.

Development of national policies and plans of action related to diet and physicalactivity

To Member States1. Determine the planning approach most relevant to country situation/needs, reviewing

the existing plans and establishing what else is needed, and determining theappropriate time-frame and what resources can be committed.

2. Develop the national plan for healthy diet and physical activity, by building on, orintegrating with the National plan of action for nutrition (NPAN), with vertical non-communicable disease plans, and with existing agriculture or national developmentplans, in conjunction with the relevant departments of education, transport, socialsecurity etc.

3. Ensure that elements such as the promotion of infant and young child feedingpractices and action to combat micronutrient deficiency through food fortification aresensitively integrated with proposed action to combat overnutrition, and that nutritionmessages in those and other respects are consistent.

4. Ensure that the departments of sport and recreation commit to healthy physicalactivity as well as to organized sport.

5. Commit to the process, and ensure that it has a champion in government, preferablythe leading decision-maker, as well as champions in other sectors.

6. Assure implementation through “joined up” national, regional, and local planning,good communication with agreed focus, definitions etc, committed funding from bothprivate and public sectors, and resources in place such as workforce, training,legislative support and research.

To WHO1. Develop a policy and plan of action template.2. Provide support, through technical papers from WHO and other agencies such as

FAO, for example on intersectoral action on nutrition and physical activity, oreconomic analyses of benefits.

3. Provide advocacy support, using resources such as governing bodies and expertise ofpartner agencies.

4. Facilitate the sharing of experience and technical evidence.

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5. Give “on-the-ground” advice and support during implementation.6. Support the development, utilization, evaluation and review of national food-based

dietary guidelines and national guidelines for physical activity.7. For the draft strategy to be considered as an intersectoral endeavor, it should be

discussed not only in the Ministry of Health, but also at Cabinet level, to obtain cross-sectoral commitment by countries.

Advocacy for government action and awareness-raising for the public (mediaand other channels)

To Member States1. Develop an advocacy plan based on evidence from established monitoring and

surveillance systems and other data streams.2. Use evidence of achievements in reducing disease rates and savings achievable by

cutting health costs to persuade politicians to put health high on their agenda.3. Use creative and relevant communication strategies to impart awareness of the issues

to policy-makers in both the health and non-health sector, and to increase publicawareness of nutrition and physical activity.

4. Identify and support champions who are committed to the goals, objectives andimplementation of national strategies on nutrition, physical activity and health.

5. Integrate health promotion initiatives into health and non-health settings, such as thecommunity, markets, schools and workplaces.

6. Provide incentives such as awards and prizes for excellent health promotionprogrammes and initiatives

7. Promote consumer education about food labelling and product information to supporthealthy choices.

8. Promote pro-health legislation that rewards people for maintaining wellness.9. Promote and popularize, through education for the general population, using mass

media, traditional healthy cooking techniques with healthy ingredients as alternatives.10. Promote physical fitness campaigns for the general population using traditional

dances and martial arts as popular vehicles.11. Seek links with programmes like tobacco control and prevention of alcohol abuse,

and mutually strengthen promotional activities such as promoting tobacco-free sportswhile promoting fitness and healthy diets.

To WHO1. Provide technical or documentary support to the efforts of countries to address the

various targets of advocacy: policy and practices, laws, marketing practices, and otherhealth promotion, sharing “best practices” from the experiences of other countries.

Food regulatory approach to support the global strategy

To Member States1. Strengthen food labelling legislation to incorporate health promotion objectives and

nutrition concerns, thus making it easier to have healthy diets.2. Make health impact assessment an integral requirement of all relevant legislative

decision-making processes.3. Mandate the inclusion of a nutrition information panel on all packaged food.4. Consider approaches to encourage nutrition information at point-of-sale for non-

packaged food, for example, the fat content of fresh meat.5. Consider the optimal regulatory approach to restrict food manufacturers’ sponsorship

arrangements in schools.

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6. Consider optimal regulatory (for example, a code of practice) arrangements forrestricting marketing of foods and drinks containing high levels of fat, sugar, salt,especially to children including television advertising, sports and concertssponsorships and point-of-sale promotions etc.

7. Review the potential commitments represented by membership of the World TradeOrganization (WTO) to reduction of tariffs and domestic subsidies on food andagriculture.

8. Promote the availability of healthy food in school canteens in line with the jointWHO/FAO report of the expert consultation on diet, nutrition and the prevention ofchronic diseases.

9. Restrict, through appropriate legislation, the availability in schools of food and drinkscontaining high levels of fat, salt and sugar, including the presence of machinesvending such foods and drinks.

10. Consider the imposition of targeted taxation on certain foods and drinks containinghigh levels of fat, salt and sugar, and incentives for the production and sale ofhealthier foods.

To WHO1. Provide technical support to review the current legislation and assess the health

impact of the development of food regulatory approaches.2. Provide support to individual countries to develop the case for mandating a nutrition

information panel on food and drink packaging.3. Explore the barriers to global harmonizing of food labelling, in collaboration with

FAO.4. Promote research into the effectiveness of food labelling in terms of its benefits to

health and make this information available to Codex through the appropriatecommittees.

5. Provide, within the framework of the WHO/FAO Codex Alimentarius, advice tocountries on best practices for the introduction of effective food labelling.

6. Identify and help to choose optional approaches to the control of food marketing andadvise Member States.

7. Provide technical expertise to support the health department in regard to tradenegotiations and implications for health of trade-related issues.

8. Provide technical expertise to support the health department in developingappropriate regulatory approaches to food availability and accessibility issues.

9. Provide technical guidance in the establishment and application of criteria fordefining high, medium and low content of fat, sugar and salt in food, based oninternationally agreed guidelines and on the levels of consumption of different foodsin countries.

Creating environments that promote physical activity

To Member States1. Develop a comprehensive national policy on physical activity that integrates with

national nutrition and other appropriate programmes to help reduce NCD risk factorsin the general population, making clear the roles of different sectors, stakeholders,NGOs and all partners.

2. Establish national physical activity guidelines that would suit different sectors of thepopulation and which are sensitive to the community’s cultural and social values.

3. Develop a national physical activity plan. This should have attainable targets and atime-line for specific interventions, and should include all sections of the population.

4. Integrate coordination of physical activity into an appropriate existing national bodyspecifically for physical activity or develop one if there is none.

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5. Establish national social marketing strategies to advocate the physical activity policyand plan to policy-makers, stakeholders, community and the general population.

6. Establish a strategy for marketing a sustainable physical activity plan to possible localand overseas donors and source funds for physical activity from diverseorganizations.

7. Establish a comprehensive and comparable national monitoring, evaluation andinformation dissemination system on physical activity if there is none, or integrate itinto an existing system.

8. Review existing national laws, and if there are none relevant to health protection,develop a bill that would include physical activity as a component, making provisionsfor direct or indirect incentives (such as tax-free status for gymnasia and fitnesscentres).

9. Work with local government to establish more venues and facilities for physicalactivity and to coordinate action by different sectors.

To WHO1. Stimulate and facilitate the provision of information and advice, funds and technical

resources with United Nations agencies and other international and national partners.2. Help identify sources of funds for sports equipment such as footballs, volleyball nets,

etc.3. Provide support to implementation of pilot projects and standards in each

environmental initiative to promote physical activity.4. Discuss roles for the private sector, including sponsorship, and facilitate the

collaboration of government, private sector and NGOs.

Promoting healthy diets and active lifestyles in specific settings

To Member States:SCHOOLS

1. Ensure the existence of, and /or strengthen the food, nutrition and physical activitycurriculum in schools.

2. Ensure that the school curriculum promotes traditional food culture and skills forpreparation of healthy food, extended to all children.

3. Ensure that schools provide physical activity options that are culturally suitable forboth boys and girls, for example traditional dances and martial arts.

4. Ensure that teachers are adequately trained and well resourced for teaching nutritionand physical activity.

5. Ensure that schools allocate a minimum level of physical activity (one hour daily).6. Ensure that there is a healthy eating policy in schools that includes contract

agreements with food providers to promote availability of healthy choices.7. Any food or drink sold in schools should meet minimum standards of food safety and

nutritional value.8. Ban the sale of food and drinks in schools exceeding the approved sugar, fat and salt

level.9. Ensure that there is no advertising or promotion of foods containing undesirable

levels of fat, salt or sugar and carbonated sugary drinks targeting children in general,especially within the school environment.

10. Design schools to include playgrounds and facilities for physical activity.11. Ensure safe walking and cycle access to schools.12. Parents and schools should work with community groups to ensure availability of

healthy food, safe water and physical activity opportunities.13. Use schools as an avenue for nutrition and physical activity education for parents.

WORKPLACES

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14. Implement a food and nutrition policy that ensures provision of healthy food atfunctions and receptions and in canteens.

15. In places where there is no alternative to foods other than those provided at worksitesprovision of healthy food choices should be mandatory.

16. In recognition of the progression from physically intensive work to desk-bound work,it is essential for workers’ health and productivity to insure a minimum level ofphysical activity as part of work scheduling.

17. Explore incentives to increase participation in physical activity, for example, throughsubsidizing club memberships and supporting active transport such as walking, orcycling.

18. Promote incidental physical activity such as taking the stairs or walking to talk tosomeone.

19. Establish a committee with representation from senior management to promotehealthy diets and physical activity.

20. Explore ways for voluntary health promotion initiatives to become occupationalhealth and safety requirements.

LOCAL GOVERNMENT/URBAN PLANNERS21. Ensure the provision of safe and accessible cycling and walk pathways.22. Provide subsidies to reduce the cost of using public physical activity facilities.23. Determine, through licensing of food outlets, what types of food are sold in the

vicinity of schools and within health care institutions.24. Make health impact assessment an integral policy requirement for major planning and

development processes at the local level. TRANSPORT

25. Foster cooperation with transport agencies to prioritize walking, cycling, and takingpublic transport.

MEDIA26. Build cooperation with media using public relations to achieve coverage of nutrition

and physical activity issues.27. Use media for social marketing campaigns and strategies.28. Consider restricting advertising of foods containing undesirable levels of fat, salt and

sugar, carbonated sugary drinks, confectionaries and slimming aids.

To WHO1. WHO should continue to support the planning, implementation and evaluation of

interventions through the "healthy settings" approach, with special emphasis onschools, as a particularly important environment for promoting healthy diets andlifestyles

Plans and processes for a regional NCD network

To Member States1. Source cross-sectoral collaborators for the network such as NGOs, donor agencies,

selected commercial entities and research units.2. Establish resources for setting up and sustaining MOANA (such as national funds,

national capacities to be shared with other members).

To WHO1. Draft a white paper for consultation and submission to Member States and other

stakeholders for their commentary and review. Develop a final version of themission, objective, and structure of MOANA.

2. Organize a regional network meeting (in May 2004) to launch the network officially.

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3. Establish the MOANA protocol, a framework for planning, implementing, evaluatingand sharing integrated approaches to NCD prevention and control.

4. Initiate and pilot a web-based networking facility.5. Propose projects for outcome evaluation and develop a best practice database.6. Propose priority areas for standard and framework development.7. Foster the contribution of relevant collaborating centres to the network.8. Provide technical expertise and other support in implementation and evaluation of

demonstration projects and national NCD plans.

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Annex List of participants

Member States

AustraliaDr John Scott, State Manager, Public Health Services, Queensland Department ofHealth, QueenslandMr Trevor Shilton (Observer), Member, Regional Committee International Union forHealth Promotion & Education, Director, Cardiovascular Health, National HeartFoundation

Brunei DarussalamDr Hajah Intan Haji Salleh Datin Paduka, Director-General of Health Services,Ministry of Health (Vice-Chairperson)

ChinaDr Chen Chunming, Senior Advisor, Chinese Center for Disease Control andPrevention, BeijingDr Wu Fan, Director, National Center for Chronic and Noncommunicable DiseaseControl and Prevention, China Center for Disease Control and Prevention, BeijingDr Zhao Wenhua, Professor; Director of Science & Technology Division, Institute ofNutrition and Food Safety, Chinese Center for Disease Control and Prevention,Beijing

Cook IslandsMs Karen Tairea, Nutritionist, Public Health Department, Ministry of Health,Rarotonga

FijiMs Nisha Khan, Chief Dietitian and Nutritionist, Ministry of Health Headquarters,SuvaMr Manasa Niubalerua, Director, Health Promotion Centre, Ministry of Health andSocial Welfare, Dinem House, Toorak, SuvaMrs Pansy Shereen Singh, Senior Education Officer (Health), andCurriculum Development Unit, National Coordinator for Health-promoting schoolsproject, Ministry of Education, Suva

JapanDr Hideshi Kuzuya, Director, Kyoto National Hospital and WHO CollaboratingCentre for Diabetes, Fukakusa Mukaihatacho Fushimiku, KyotoDr Shigeru Yamamoto, Professor, Applied Nutrition Department of AppliedNutrition, School of Medicine, The University of Tokushima, Tokushima

KiribatiDr Airam Metai, Director of Public Health Services, Ministry of Health, Tarawa

Republic of KoreaMr Jeong Chung-Hyeon, Senior Deputy Director, Health Promotion Policy Division,Ministry of Health and Welfare, Kwachon City, Kyunggi-DoDr Cho-il Kim, Chief and Head Researcher, Nutrition Research Team, Korea HealthIndustry Development Institute, Seoul

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MalaysiaDr Zainal Ariffin Omar, Deputy Director, Disease Control Division, Ministry ofHealth Malaysia, Kuala Lumpur (Chairman)Dr Shafie bin Ooyub, Director, Disease Control Division, Department of PublicHealth, Ministry of Health Malaysia, Kuala LumpurHon. Dato' Dr Abdullah Fadzil Bin Che Wan (Observer), Member of Parliament,Kuala LumpurHon. Senator Jaya Partiban (Observer),Member of Parliament, MalaysiaAsian Forum of Parliamentarians on Population and Development, Parliament House,Kuala LumpurMs Somsiah Parman (Observer), Principal Assistant Director for Nutrition, NutritionSection, Division of Family Health Development, Ministry of Health Malaysia,Kuala LumpurMr Abdul Rahman Wahab (Observer), Schools Division, Ministry of Education,Kuala Lumpur

MongoliaDr Gombodorj Tsetsegdary, Senior Officer-in-Charge, NCD and MNH, Focal Point,MNH and TOH, Ministry of Health, UlaanbaatarMrs Ser-Od Tsetsgee, Head, Food Production Division, Ministry of Food andAgriculture, UlaanbaatarDr Chimedregzen Ulziiburen, Director, Nutrition Research Centre, Public HealthInstitute, Ulaanbaatar

New ZealandMs Elizabeth Aitken, Senior Advisor (Nutrition), Public Health Policy, Public HealthDirectorate, Ministry of Health, WellingtonMr David Roberts, Cardiac Care Setting, The National Heart Foundation of NewZealand National Office, AucklandDr Colin Tukuitonga, Director of Public Health, Public Health Directorate, Ministryof Health, Wellington (Rapporteur)

PhilippinesDr Rolando Enrique D Domingo, Assistant Secretary for Health Regulations/Officer-in-Charge, Degenerative Disease Office, Department of Health, Manila

SingaporeDr Mei Chuan Annie Ling, Head, Nutrition Programme, Health Promotion Board

TongaMrs Vizo Noeline Halavatau, Principal Nutrition Planner, Central PlanningDepartment, Government of Tonga, Nuku'alofaDr Viliami Puloka, Medical Officer, Special Grade in Charge of Health Promotionand NCD, Ministry of Health, Nuku'alofa

Socialist Republic of Viet NamDr Ly Ngoc Kinh, Director, Department of Therapy, Ministry of Health, HanoiDr LeVan Kham, Expert/Medical Officer, Department of Therapy, Ministry ofHealth, Hanoi

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Resource persons

Professor Kaare R Norum, Chairman, Reference Group for the WHO Global Strategy onDiet, Physical Activity and Health; Institute for Nutrition Research, Faculty of Medicine,University of Oslo, NorwayProfessor Adrian Bauman, Professor of Public Health and Epidemiology, University of NewSouth Wales, Director NSW Centre for Physical Activity and Health Epidemiology Unit,Liverpool Hospital, New South Wales, Australia (Technical presentation: Physicalactivity programmes)Professor Cecilia Florencio, Professor, University of the Philippines, Department of FoodScience and Nutrition, College of Home Economics, Diliman, Quezon City, The Philippines(Technical presentation: Dietary guidelines development and utilization in theRegion)Dr Mark Lawrence, Senior Lecturer (Food Policy and Regulation), Centre forPhysical Activity and Nutrition, Deakin University, Victoria, AustraliaDr Tee E-Siong, President, Nutrition Society of Malaysia, Petaling Jaya, SelangorDE, Malaysia

United Nations Organizations And Intergovernmental Organizations

Food and Agriculture Organization of the United Nations (FAO)Dr Biplab K Nandi, Senior Food and Nutrition Officer, FAO Regional Office for Asiaand the Pacific, Bangkok, Thailand

Secretariat of the Pacific Community (SPC)Ms Wendy Snowdon, Nutrition Education and Training Officer, Lifestyle HealthSection, Secretariat of the Pacific Community, Noumea New Caledonia

United Nations Economic and Social Commission for Asia and the PacificMr Kim Ganglip, Expert on Health and Development for Asia and the Pacific, Healthand Development Section, Emerging Social Issues Division, UNESCAP, Bangkok,Thailand

WHO Secretariat

Dr Tommaso Cavalli-Sforza (Responsible Officer) Regional Adviser in Nutrition and FoodSafety, WHO Regional Office for the Western Pacific, Manila, PhilippinesDr Maximillian De Courten, Medical Officer, Noncommunicable Diseases, Office of theWHO Representative in the South Pacific, Suva, FijiDr Gauden Galea (Co-responsible Officer), Regional Adviser in Noncommunicable Diseases,WHO Regional Office for the Western Pacific, Manila, Philippines (Technical presentation:Regional NCD network)Dr RW Kingsley Gee, Acting WHO Representative Malaysia, World HealthOrganization, Kuala Lumpur, MalaysiaDr Sophie Leonard, Associate Professional Officer in Nutrition, WHO Regional Office forthe Western Pacific, Manila, PhilippinesDr Linda Milan, Director, Building Healthy Communities and Populations, WHO RegionalOffice for the Western Pacific, Manila, PhilippinesDr Chizuru Nishida, Technical Officer, Department of Nutrition for Health and Development,Sustainable Development and Healthy Environments, World Health Organization, Geneva,SwitzerlandDr Pekka Puska, Director, Noncommunicable Disease Prevention and Health Promotion,

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WHO, Geneva, Switzerland (Technical presentation: Towards a global strategy on diet,physical activity and health)Mr David Porter, Media Officer, WHO Global Strategy on Diet Physical Activity andHealth, World Health Organization, Geneva, SwitzerlandMs Alison Rowe, Report writerMs Amalia Waxman, Project Manager, Process for Global Strategyon Diet, Physical Activity and Health, Noncommunicable Diseases Prevention andHealth Promotion, World Health Organization, Geneva, Switzerland